Gambling: Pastime or illness?

As a teen, Scott Damiani got adults to place bets for him at a horse track. He wagered instead of studying, losing college scholarships when his grades plummeted. Over the years, he maxed out 14 credit cards, sold his house to pay debts and kept betting. At 53, he tried to kill himself.

"There were times I tried to control my addiction, but I never considered quitting because, lo and behold, I'd win a lot of money," said Damiani, who has been in a 12-step program and now is executive director of the Downers Grove-based Outreach Foundation, a state-funded gambling awareness effort. "No matter how bad life is, you tell yourself that, 'If I win, it'll be OK.' But you can never win enough."

It's a familiar refrain to Dr. Jon Grant, professor of psychiatry and behavioral neuroscience at the University of Chicago, who has embarked on a multiyear study to try to identify predictors of problem gambling. His goal is to make addiction screening a routine part of physical exams, not unlike that for heart disease and diabetes.

Grant's work is part of a recent wave of activity focusing on problem gamblers. Among other developments:

•The American Psychiatric Association's recently updated diagnostic manual now designates problem gambling as an addiction instead of a pathological or an impulsive disorder. Though gambling often has been considered an addiction by many, the new designation in a key reference book used by mental health professionals could change how it is diagnosed and treated.

•The Illinois Alliance on Problem Gambling was launched in May by the Illinois Gaming Board, the Illinois Lottery, Rush University Medical Center, and the Illinois Institute for Addiction Recovery to coordinate resources and efforts.

The developments come as lawmakers in many state and local governments continue to see gambling expansion as a way to shore up shaky finances. Illinois, which recently rolled out legalized video poker machines, is considering additional casinos at four sites and slot machines at horse tracks and Chicago airports.

Though problem gambling is almost always part of expansion discussion, politicians tend to play the percentages — it's more palatable to avoid raising taxes, despite estimates that up to 5 percent of gamblers develop a problem and that more gaming venues mean more compulsive gamblers.

With a $400,000 grant, Grant will enroll and follow hundreds of young people with some exposure to gambling to see who develops an addiction. The study examines their backgrounds and personalities for impulsive behavior, conducts periodic brain scans, and tests saliva for possible genetic markers.

"Maybe we could say to an 18-year-old, 'If you have this profile, this family, this type of personality and perform this way on tests, you have a 90 percent chance of developing an addiction,'" Grant said.

Heading off an addiction is preferable to treating one, said Grant, who estimates 60 percent to 70 percent of problem gamblers could improve with medicine and therapy. "But gamblers don't know of treatments, and neither do clinicians," he said.

Grant's work is behind U. of C. being named a Center of Excellence in Gambling Research, one of two such facilities in the country focusing on impulse-related addictions. The other is at Yale University. (The work is funded by the National Center for Responsible Gaming, which gets money from the gambling industry that it directs toward research proposals peer-reviewed by scientists and others.)

Easier access to gambling

Illinois legalized video gaming in 2009, and the machines went into use last year. They are permitted in establishments with liquor licenses, but cities and towns were given the right to prohibit them, though they earn 5 percent of the gross wagered if they allow them.

As many as 400 communities initially said no, according to Gene O'Shea of the Illinois Gaming Board. But as local businesses applied pressure, arguing they and the governments were losing money, the number banning video gaming has dropped to 221, he said.

Thirteen terminals were live in September, bringing in just over $1 million in wagers and paying the combined municipalities $4,500 in taxes, according to a report on the state Gaming Board website. By March, the list of locations had grown exponentially, bringing in a total of $242.5 million wagered. The municipalities earned $939,500 in taxes that month.

The easy access of these games, coupled with the proliferation of online gambling, is leading to problems developing at a younger age. Fred L., a trustee for Gamblers Anonymous, whose members by tradition are only partially identified, said 10 years ago there was nobody younger than 30 at meetings.

"We're seeing more and more," he said, pointing particularly to the popularity of Texas Hold 'em, a variation of poker. The games aren't regulated, as casinos are with self-exclusion lists and betting limits, he said, and "suck people in and then start draining your wallet."

Fred's passion was casinos. He traveled for work, and when he got bored, he played the slots. "After a while, it was all I wanted to do," he said.

On Sept. 11, 2001, he checked in with his family, then hit the gaming floor in Minnesota. "It was a great place to hide" from the horrors in New York and Washington, he said.

He estimates he lost close to $200,000 over the years, beginning with bets among his siblings and father during childhood pinochle games. He laughs at the idea of heeding a warning about his behavior.

"Are you crazy? At age 18, you think you're bulletproof," Fred said.

Another Gamblers Anonymous trustee, Rich S., needed two stints, 15 years apart, in the program to finally stop gambling.

"I knew what I was doing was not right," he said of the drinking and gambling that escalated after he returned from the Vietnam War. "But I couldn't stop."

Similar to substance abuse

It's the classic definition of addiction, which is what gambling is being labeled in the revised American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, which was released in May. The manual defines criteria to help ensure that diagnoses are accurate and consistent among clinicians, who submit claims to insurers and reports to public health authorities.

Before DSM-5, "pathological gambling" was labeled an impulse control disorder identified by 10 criteria, which included committing illegal acts to gain money, lying to family members and jeopardizing or losing a significant relationship, job or educational opportunity. It was listed with pyromania and kleptomania, among other disorders.

Now, problem gambling is listed with addictions.

"This new term and its location in the new manual reflect research findings that gambling disorder is similar to substance-related disorders in clinical expression, brain origin, comorbidity, physiology and treatment," Dr. Charles O'Brien, chair of the DSM-5 Disorders Work Group, wrote in an email.

"Recognition of these commonalities will help people with gambling disorder get the treatment and services they need, and others may better understand the challenges that individuals face in overcoming this disorder," O'Brien wrote.

Whether that means insurance will cover treatment for problem gamblers, as it often does for drug and alcohol abusers, remains to be seen.

Grant, who has a clinical practice at U. of C., knows gamblers face financial obstacles to treatment as well as a general lack of attention and knowledge about their problems.

"Gamblers think of it as a character flaw because doctors don't ask about it, so then it's not a medical problem," he said. "And it never made sense to me that a person about to lose his house has to pay for treatment."

It makes sense to treat problem gamblers, he said, but even more sense to try and head off the misery that addiction can cause.

"Wouldn't it be great to be able to say we know the warning signs?" Grant said. "Education is a wonderful prevention. And so much cheaper than treatment."

Fred L. acknowledges he wouldn't have listened to predictions that his teenage behavior could lead to him finally having to admit, "I could not stop. I had to choose not to go (to casinos) because I couldn't take the pain anymore."

Still, he applauds the idea that such warnings could someday be available.

Grant "would do incredible good for thousands and thousands of people now and in the future," Fred L. said, "if he can come up with something."